clinical anaesthesia training - College of Intensive Care Medicine

College of Intensive Care Medicine
Of Australia and New Zealand
CLINICAL ANAESTHESIA TRAINING
IN-TRAINING ASSESSMENT FORM
TO BE COMPLETED BY SUPERVISOR OF TRAINING FOR ANAESTHESIA
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SECTION A
THIS FORM IS IMPORTANT. In-training assessments of College Trainees must be conducted at six monthly intervals from the
commencement of the Trainee’s employment year, or in the case of a shorter attachment, at the conclusion of the attachment, in
accordance with Document T-12 “Guidelines for the In-Training Assessment of Trainees in Intensive Care Medicine”.
Assessments are completed by the Supervisor of Training based on the consensus views of the majority of senior staff in the
Department. Participating staff must have a personal knowledge of the trainee. This assessment should be signed by the Trainee
following discussion of the assessment with the Supervisor of Training.
When completed, the Supervisor must also sign this form before forwarding it to the Administrative Officer for Training within 2
weeks. The Trainee must retain a copy of the signed form within their training portfolio. Trainees have the right of appeal with
regards to matters of process.
Name of Trainee
Surname Other names (in full)
Report covers period From / / To / /
Details of any leave taken Annual: week (s) Study: week (s)
Supervisor
Hospital
Sick: week (s) Conference: week (s)
Other: week (s) Specify:
Surname Other names (in full)
Training Discipline: ANAESTHESIA
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SECTION B SUMMARY
a) Have you been satisfied with the overall professional performance Yes No
of the Trainee during the period covered by this report?
b) Would you recommend that this period Yes No
of training be fully accredited?
If No, what proportion of the year or training period would you recommend to be accredited?
3 Months Nil Other . . . . . .
c) Has the Trainee satisfied the aims of the Anaesthesia term (as set out in the Objectives of
Training – The Anaesthesia Term document)?
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Yes No

SECTION C ASSESSMENT OF THE CURRENT PERIOD OF TRAINING
Please rate the trainee’s performance for each topic area by placing a rating of 1-5 in the box next to each topic area.
Interpretation of the Rating Scale
Falls far short of expected standards
Falls short of expected standards
Consistent with level of training
Better than expected standards
Exceptional performance
Medical Knowledge related to peri-operative medicine
Demonstrates up-to-date knowledge required to manage a range of patients peri-operatively
Application of Medical Knowledge
Shows ability to use the knowledge and other derived evidence based information
Procedural Skills
Demonstrates ability to perform the range of procedures relevant to anaesthesia
Interpersonal/Communication Skills
Demonstrates ability to relate to and communicate with colleagues and other staff
Clinical Judgement
Demonstrates ability to integrate cognitive and clinical skills, and consider alternatives in making
diagnostic and therapeutic decisions
Responsibility
Accepts responsibility for own actions and understands the limitations of own knowledge and
experience
Problem Solving Skills
Critically assesses information, identifies major issues, makes timely decisions and acts upon
them
Humanistic Qualities
Demonstrates integrity and compassion in patient care
Respect
Shows personal commitment to honouring the choices and rights of other persons; shows cultural
sensitivity
Moral and Ethical Behaviour
Exhibits high standards of moral and ethical behaviour towards patients and families
Professional Attitudes and Behaviour
Shows honesty at all times in their work; puts patient welfare ahead of personal consideration
Patient Management
Shows wisdom in selecting treatment; adapts management to different circumstances
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Please rate the trainee’s performance for each topic area by placing a rating of 1-5 in the box next to each topic area.
Initiative
Shows initiative in care of patients and development of anaesthetic plans
Reliability, dependability
Is steadfast in undertaking duties and responsibilities applicable to role
Ordiliness and tidiness
Maintains an organised, clean and safe work environment
Quality Assurance
Demonstrates an understanding of anaesthesia Quality Assurance measures
Record Keeping
Maintains complete and orderly anaesthetic records and (where necessary) up-to-date progress
notes
Handover
Ensures that all problems are explained during handover to colleagues and other staff
Crisis management
Demonstrates an ability to recognise and appropriately respond to emergency situations and to
coordinate the emergency response as required.
Relationships with Medical Staff
Maintains the respect of his/her colleagues
Interpretation of the Rating Scale
Falls far short of expected standards
Falls short of expected standards
Consistent with level of training
Better than expected standards
Exceptional performance
Relationships with Health Professionals
Demonstrates ability to work well and efficiently in the health care team; values the experience of
others
Enthusiasm
Demonstrates a willingness and keenness to participate in all aspects of anaesthetic practice.
Organisation Skills
Demonstrates ability to plan, coordinate and complete tasks associated with anaesthetic care
Self Assessment
Accepts the limits of own competence and functions within own capabilities; seeks advice and
assistance when appropriate; accepts criticism
Continuing Education
Shows a resourceful attitude towards continuing education to enhance quality of care
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SECTION D
SUPERVISOR’S COMMENTS (including strong points and weak points)
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TRAINEE’S COMMENTS: I have discussed this assessment with the Supervisor of Training for the
anaesthesia term I am aware that this assessment will form part of my training record and that it will be considered by the College in
respect of a decision to award Fellowship. I make the following comments:
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Signature of Trainee: ______________________ Date: ____/____/_____
SUPERVISOR’S ADDITIONAL COMMENTS: In light of discussion with the Trainee, I note the following:
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Signature of Supervisor: ______________________ Date: ____/____/_____
SATISFACTORY UNSATISFACTORY
Please forward the original, signed copy to the Administrative Officer for Training within 2
weeks. Copies of the completed form should be retained by the Supervisor and the trainee.
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